The Los Angeles Times has landed yet another of its string of powerful investigations into Purdue, the family owned maker of OxyContin, one of the powerful painkillers at the heart of the prescription drug abuse crisis. The paper finds that Purdue responded to a tide of adverse publicity and declining sales in the United States by reorganizing its efforts into a web of related companies overseas, all under the umbrella name Mundipharma.

This conglomerate is pushing OxyContin hard, globally, with all the practices that regulators, policy-makers, public health and law enforcement officials have ripped Purdue for in this country. As the newspaper has reported:

In Brazil, China and elsewhere, [Mundipharma] companies are running training seminars where doctors are urged to overcome ‘opiophobia’ and prescribe painkillers. They are sponsoring public awareness campaigns that encourage people to seek medical treatment for chronic pain. They are even offering patient discounts to make prescription opioids more affordable.

The drug maker also is sending around the world American physicians whose credentials get burnished to make them seem more authoritative as they pitch the virtues of prescription painkillers in seminars and other professional sessions. These experts and Mundipharma’s OxyContin hype downplay or ignore how addictive OxyContin can be.

The Los Angeles Times says Mundipharma, if unchecked, could replicate the opioid drug crisis in Latin America, Asia, the Middle East, and Africa. Many of the markets it is targeting are in poorer, less developed nations little able to handle their existing, huge public health challenges, much less the havoc that opioid drugs have created in America, where the paper says 200,000 lives have been lost to painkiller abuse and overdoses.

David A. Kessler, a physician and the former federal Food and Drug Administration chief who has called the prescription drug abuse epidemic one of the United States’ great regulatory failures, told the Los Angeles Times that Mundipharma’s actions are “right out of the playbook of Big Tobacco. As the United States takes steps to limit sales here, the company goes abroad.”

If regulators and law enforcement officials may have seemed slow to deal with the opioid drug crisis, a Washington Post investigation may provide insight why: The paper says that since 2005, when the federal Drug Enforcement Agency began to attack illicit sales of pain killers like oxycodone, Big Pharma has targeted the drug cops’ top echelons, recruiting and hiring away 42 of the agency’s brass. The specific DEA division that seeks to curb illegal medication sales got picked clean by Big Pharma of 31 of its leaders, the Post says, detailing how the agency’s aggressive attack on prescription painkillers slowed as it leadership ranks thinned.

John Carnevale, former director of planning for the White House’s Office of National Drug Control Policy, told the paper:

“The number of employees recruited from that division points to a deliberate strategy by the pharmaceutical industry to hire people who are the biggest headaches for them. These people understand how DEA operates, the culture around diversion and DEA’s goals, and they can advise their clients how to stay within the guidelines.”

Although federal law seeks to curb or even to bar “revolving door” employment, where those with oversight over an industry leave the government and go to work in it, Big Pharma executives and the few former DEA staffers, who were contacted by the paper and who would be quoted, insisted they had followed applicable regulations.

Survey draws stark picture of users and why painkillers are so popular

Let’s be clear: besides Big Pharma, physicians have played a terrible role in this health menace, whether their intentions were good (to relieve pain) or no. The Washington Post and the Kaiser Foundation, with a national survey and follow-up reporting, have found that opioid drug users get started with the drugs via their doctors (97 percent of respondents). They report they suffered great pain from accidents, surgeries, and diseases like cancer, and the opioids offer them initial and dwindling relief. But increasing numbers find themselves quickly hooked on the drugs, with many advancing to increasingly powerful and often illicit opioids, including super designer drugs like fentanyl, and illegal heroin. Some respondents, roughly a third said they use the drugs now to get high or to relieve stress. Those who now struggle with addiction include infants, especially in rural and poor areas, and unsuspecting seniors.

Drew Altman, the head of the Kaiser Foundation, recently has drawn in the Wall Street Journal a dismally broad, survey-based portrait of what the opioid drug abuse epidemic looks like:

Six in 10 long-term opioid users were between 40 years old and 64 years old. Less than a quarter worked full time and 33 percent were on disability or retired (20 percent). Seventy percent of long-term users said they have a debilitating disability or chronic disease. Long-term users are slightly more likely to live in rural areas; the problem of opioid overdoses is especially acute in rural America, where treatment is scarce and Emergency Rooms and jails can’t handle the problem. …

I’ve written before how physicians, regulators, policy-makers, politicians, and, yes, Big Pharma must step up to deal with the opioid drug abuse crisis. A great deal of credit is due to the journalists and news organizations that are dogging this woe. I look forward to the follow-up by U.S. public health leaders to aggressively clue in their global counterparts about the terrible harms that opioid painkillers have caused in this country. We should all look for congressional leaders to ask tough questions about Big Pharma and the DEA, and I hope that West Virginians put their public officials on the griddle as to why state laws didn’t do more to prevent a drug inundation. I certainly see in my practice the tragic effects that can result from dangerous medications, and I know all too well from decades of experience with Big Tobacco how insidious it can be for high-powered American corporations to move their avarice around the globe. We’ve got a lot of work to do in 2017 to tackle this crisis and others to improve our health.

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